Small Bowel Follow-Through

Question 1

Indications for Small Bowel Follow Through

Answer 1

Usually r/o small bowel obstruction in the setting of h/o NEC, h/o abdominal surgery, h/o gastroischisis/omphalocele (these kids tend to get a lot of small bowel obstructions)

Question 2

Contrast for Small Bowel Follow Through

Answer 2

Barium preferred so it doesn’t become too diluted, however, if recent surgery, newborn baby–>use Omnipaque 300

Question 3

Table position for Small Bowel Follow Through

Answer 3

• Perform UGI protocol
• Will usually need additional contrast once UGI is complete
  IN GENERAL (individualize per patient/radiologist recs):
• Keep pt in the fluoro room either sitting up on lying R lateral, take image (exposure) after 10-15 minutes to document progression into jejunum.
• If inpatient at this point may send back to room or if outpatient have them go to the waiting room or walk around and take another image in roughly 30 minutes (so will be a 45 minute image)
• From here make continue to space out serial images depending on what you’re seeing, until contrast gets to the cecum/colon.

Question 4

Protocol for for Small Bowel Follow Through for Harris NICU

Answer 4

• Perform UGI
• Wait roughly 15 minutes and take another image to document progression into jejunum
• Decide here if pt needs additional contrast; may also send additional contrast back to Harris with nurse in case additional is needed later in the exam
• If contrast is progressing as expected, we usually close this portion of the exam. Include in your dictation that “serial imaging will continue once patient returns to Harris NICU to follow contrast as it transits to the colon”.
• Pt goes back to Harris NICU. You will ask RN to notify the NICU MD or NNP at Harris to obtain a KUB once they arrive there or in “x” minutes. This is the extent of your responsibilities.
• Once KUBs start being done at Harris, the radiologist assigned to “Pod 4” will read them and is supposed to include in his/her dictation when the next image should be and it becomes the responsibility of the Harris team to manage.